Provider Demographics
NPI:1750321170
Name:KIYANFAR, CYRUS (CRNA)
Entity Type:Individual
Prefix:MR
First Name:CYRUS
Middle Name:
Last Name:KIYANFAR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51163
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1163
Mailing Address - Country:US
Mailing Address - Phone:985-384-2200
Mailing Address - Fax:
Practice Address - Street 1:1125 MARGUERITE ST
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1855
Practice Address - Country:US
Practice Address - Phone:985-384-2200
Practice Address - Fax:985-380-4545
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03410367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1558397Medicaid
LA5X963Medicare PIN
LA1558397Medicaid